Ann Thorac Surg 2001;72:946
© 2001 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Pleural herniation through an intercostal space
Kristijan G. Minanov, MDa,
Carl M. Pesta, DOa,
Michael L. Thornton, DOa
a Department of Cardiothoracic Surgery, Mount Clemens General Hospital, Mount Clemens, Michigan, USA
Address reprint requests to Dr Minanov, Cardiac Surgery Institute, P.C., 22151 Moross, Suite 203, Detroit, MI 48236
e-mail: kdminanov{at}home.com
A 64-year-old morbidly obese male with a remote tobacco history presented with progressive left-sided pain, transient flank hematoma, and chest bulge following a severe coughing episode. Physical exam revealed a balottable mass at the left eighth intercostal space. Computed tomography of the chest revealed a herniation of the lung and pleura through the rib space (arrow, Fig 1). The patient was taken to the operating suite where a standard posterolateral thoracotomy was performed. Intraoperative findings revealed a 10 x 8 cm hernia sac containing diaphragm and the lower lobe of the left lung (arrow, Fig 2). Additionally, there was disarticulation of the ninth costochondral junction. We theorized that this patient disarticulated his costochondral junction during the coughing episode. This, along with his significant abdominal girth, led to his thoracic hernia formation. There was no associated pathology noted. After takedown of the hernia sac, the ribs were reapproximated with 0-0 Vicryl (Ethicon, Somerville, NJ) suture, followed by standard closure of the thoracotomy. The patient recovered uneventfully. Follow-up has shown no evidence of recurrence.
